Ask Questions That Make Sense in the Culture

I think people talk a lot about cultural validity, but I think there are different aspects of cultural validity because there are aspects that have to do, at least in my experience, with the cognitive abstraction that you're asking people to do. So sometimes it's not necessarily only culture in the sense of you have to think about what is the situation of this person in terms of cognitive abstraction in the terminology that you're using.

For example in our studies with Latinos and Asians, one of the things we've seen is people have a lot of problems in making this assessment in terms of time dimension, so I think we're asking a lot of diagnostic measures, "When was the first time you had this combination of symptoms?" And people are like, "Combination of symptoms?" People are at a loss, so I think sometimes we ask people some questions that are really not akin to how they see the problems. So I think it's not only the cultural aspect relating to ethnicity, race, or your circumstances, but how does the question make sense to you? So that's one aspect.

I think that there's the cultural aspects about questions that make no sense given the living circumstances. I always say, one time someone dear to me asked me, Will you help me with a scale that we want to change to the Latino population, put in Spanish? But it's for a homeless population, and one of the questions they were asking is how much salt intake do you do? And when I did the focus groups, people were laughing on the floor. They were like, "How would you ask us about salt? We can't even, we're not even sure we're going to get a meal. That would never enter our thought process." So the circumstances of where people live and what makes sense to them is very important.

Some of the terminology with respect to feelings is so difficult. That's the area where I'm finding how people respond to certain concepts of feelings because we don't necessarily have an equal term in the language or in your experience, so I think that that's the part where qualitative methods are so useful in trying to capture. But even when you think about concepts like often. Often might mean something very different to someone in one context than another, so when you're actually saying, "I often do that."

I think also sometimes when you're doing these studies, you actually start seeing how the way you're asking the questions might not illicit the information you're trying to look for. So for example one of the things we found in this study is we were asking people about their incomes, but then we found out a lot of the immigrant population sends money to their country of origin. So if you only ask about the income that they receive and don't ask about the income they send, you actually get a very distorted view about how much income they actually have.